Navigating Aged Care Services with GIS: Trends, Developments, and Future Directions

Background With the growing challenge of an aging population, emerging technologies are increasingly being integrated into the production, organization, and delivery of aged care services. Geographic Information System (GIS), a computer-based tool for spatial information analysis and processing, has made significant strides in the allocation of care recources and service delivery for older adults, a notably vulnerable group. Despite its growing importance, cross-disciplinary literature reviews on this theme are scare. This scoping review was conducted to encapsulate the advancements and discern the future trajectory of GIS applications in aged care services. Methods A comprehensive search across nine databases yielded 5941 articles. Adhering to specific inclusion and exclusion criteria, 61 articles were selected for a detailed analysis. Results The 61 articles span from 2003 to 2022, with a notable increase in publications since 2018, comprising 41 articles (67% of the total) published between 2018-2022. Developed countries contributed 66% of the papers, with 45% focusing on accessibility issues. In the domain of aged care services, GIS has been predominantly utilized for model construction, mapping, and site selection, with a growing emphasis on addressing the unique needs of different subgroups of older adults. Conclusion The past two decades have seen substantial growth in the application of GIS in aged care services, reflecting its increasing importance in this field. This scoping review not only charts the historical development of GIS applications in aged care services but also underscores the need for innovative research approaches. Future directions should emphasize the integration of GIS with diverse methodologies to address the heterogeneous needs of older adults and improve the overall delivery of aged care services. Such advancements in GIS applications have the potential to significantly enhance the efficiency, accessibility, and quality of care for the aging population.


Introduction
In the context of burgeoning global economic development, the phenomenon of an aging population is increasingly prominent.It is projected that the world's population will surpass the eight billion mark by November 15, 2022.A noteworthy trend in global demographics is the rise in life expectancy, which reached an average of 72.8 years in 2019, marking an approximate increase of nine years since 1990.This upward trajectory is expected to continue, with projections suggesting an average global longevity of 77.2 years by 2050 [1].This increase in life expectancy can be attributed to a confluence of factors, including a worldwide decrease in birth rates, advancements in medical technology, and overall societal progress.These factors have not only contributed to extended human life spans but also led to significant shifts in mortality rates and demographic patterns, thereby influencing various facets of global society.In light of these changes, there is a pressing need to focus comprehensively on the healthcare, social security, and emotional well-being of the elderly.This demographic shift calls for a global response, urging nations to address the health requirements of their aging populations.Despite the increase in longevity, the question arises: are the needs for aged care services being adequately met?In response to this critical societal challenge, governments across the world are taking proactive measures.They are formulating and implementing policies aimed at safeguarding the lives of the elderly and fulfilling their diverse needs, thereby ensuring their well-being in the later stages of life.
The spectrum of care services for the elderly encompasses both physical and mental well-being.Ensuring access to comprehensive healthcare services is crucial for maintaining healthy lifestyles among older adults [2].Care services for this demographic are distinct and more specialized compared to those for younger populations.Given their often-diminished physical robustness, the lifestyle and mental health needs of the elderly differ markedly from those of younger adults.However, there is a notable gap in the existing literature pertaining to care services, with insufficient attention to the multifaceted nature of aged care.A segment of research focuses primarily on the physical health aspects of the elderly, such as oral health, advocating for an expansion in geriatric dental services to meet growing demands [3].In contrast, other studies emphasize the logistical aspects of accessing aged care services, including the influence of public transport's accessibility and reliability on seniors' ability to reach medical facilities.This diversity of focus highlights the complexity inherent in defining care services for the elderly.Consequently, this paper adopts a broader perspective, encompassing health care, housing, nutrition, and psychological support as integral components of elderly care.Additionally, it addresses factors that directly impact seniors' access to these services, such as the availability of transportation, thereby acknowledging the comprehensive nature of care requirements in older age.
In the realm of aged care services research, the application of Geographic Information Systems (GIS) for analysis and evaluation has garnered attention.Initially proposed by Roger Tomlinson in 1963 [4], GIS technology has undergone significant evolution and found widespread application across various disciplines over the decades.The past fifty years have witnessed remarkable advancements in GIS research, showcasing its potential value in diverse fields and its emergence as a crucial technology in everyday human life.One key area where GIS has shown its utility is in understanding the spatial distribution of medical resources and its correlation with accessibility and availability [5].The well-being of older adults is closely linked to the availability of healthcare resources, and the spatial distribution of these resources directly influences the distribution of public welfare [6].
The integration of GIS in healthcare has revolutionized the measurement of spatial access to healthcare services [7], enabling more efficient calculation of resource allocation.With advancements in computing technology, GIS techniques have been increasingly used to develop optimal solutions for allocation challenges.These methods are continuously evolving [8][9][10][11], aligning more closely with research needs and societal changes.Research that combines socio-economic, demographic, and spatial factors in the context of care services has gained significant interest.
Given the demographic shift towards an aging population, exploring the application of GIS from a technical perspective is pivotal in addressing age-related challenges.GIS can play a crucial role in reducing inequities in access to aged care services.However, the literature on GIS applications within the field of aged care remains comparatively sparse.This scoping review aims to elucidate the specific aspects of aged care services, investigate the precise application of GIS in this domain, and discern the variations across different countries/ regions and over time.

Methods
This scoping review was conducted through a structured five-step process, each step briefly outlined as follows:

Identification of review questions
Employing the methodological framework established by Arksey and O'Malley, this review delved into the application of GIS within the realm of aged care services.Arksey and O'Malley's seminal work in 2005 laid the groundwork for conducting scoping reviews, providing both rationale and methodological guidance [12].Adhering to their framework, this scoping review investigated the integration of GIS in aged care services, an area that had seen limited scholarly exploration.By synthesizing three key elements-older adults, care services, and GIS-this paper sought to unpack the intricacies of GIS application in aged care.The review specifically addressed the following three pivotal questions: 1. What are the prevailing demands within aged care services?2. How is GIS being applied in the sphere of aged care services?3. Are there any spatial-temporal variations in the application of GIS within this field?

Literature retrieval
Literature retrieval for this scoping review was conducted across nine databases, encompassing five Chinese databases: CNKI, CSSCI, CSCD, VIP, and Wanfang; and four English databases: Web of Science, PubMed, Elsevier, and EBSCO.A comprehensive search strategy was implemented in these databases without imposing restrictions on publication date or geographic region of the literature.Rigorous documentation and categorization of the retrieved literature were undertaken, laying the groundwork for subsequent screening processes.The specific search strategies employed are outlined in Table 1.The search was completed up to May 2022, hence recent publications from June 2022 onwards were not included.To enhance the efficiency and accuracy of literature deduplication, we utilized the Covidence assessment system software (https:// www.covid ence.org/), which aided significantly in the preliminary screening of the literature.

Inclusion/exclusion criteria
In order to ensure that the selected literature aligned with our study objectives, an additional research team member was involved in examining the relevance and quality of the papers.Two team members collaboratively conducted the screening of necessary articles.This preliminary screening involved reviewing each article's title, abstract, and keywords to determine its potential inclusion in our study.
The criteria for inclusion in this review were as follows: 1.The primary focus on older adults aged 60 and above.
2. Utilization of GIS-related technology or methodologies.3. Coverage of care or health services.
Conversely, the exclusion criteria were: 1. Articles that were reviews, conference proceedings, newspapers, books, dissertations, etc. 2. Studies where the target population was not primarily older adults, but included other demographic groups such as children and adults under 60 years old.3. Articles that did not involve care or health services.4. Lack of GIS technology or method application.5. Articles that were not accessible or where the full text was unavailable.6. Duplicate publications.

Consultation and determination
During the screening process of articles, instances arose where it was uncertain whether certain literature should be included.In such cases, consultation with another research team member was essential to make determinations based on the established inclusion and exclusion criteria.In scenarios where controversies persisted, a thorough review of the complete text was necessary to ascertain compliance with our inclusion requirements.Despite occasional minor contradictions, these articles were still considered eligible for inclusion in our research.

Evaluation
To comprehensively evaluate the selected articles, we assessed the overall quality based on five key aspects: research objectives, literature review, methodology, results, and significance.Each aspect of each article was graded according to the criteria outlined in Table 2, ensuring adherence to quality reporting standards [13].For ease of scoring, we employed a four-level rating system: 0 for not meeting the standard, 1 for nearly meeting the standard, 2 for meeting the standard, and 3 for exceeding the standard.Out of the 65 articles evaluated, scores ranged from 7 to 14. Considering that a score of 2 per aspect indicates meeting the standard, and thus a cumulative score of 10 across all five aspects, articles scoring below 10 were excluded.Consequently, 4 articles scoring under 10 points were omitted, leaving 61 articles that met the criteria for this scoping review and were included in the analysis.Older adult OR "older adults", "ageing population", "elderly", "geriatric", "older people", "senior" Care services OR "care service", "caring service", "health care"

Charting
Accurate and detailed data of the articles meeting the inclusion criteria were meticulously recorded in an Excel spreadsheet.This record included information such as title, author(s), publication year, research area, number of citations, target population, research methodology, and key findings.

Results
Following the aforementioned methodology, we initially screened a total of 5941 articles.Among these, 4183 were identified as duplicates and subsequently removed (as illustrated in Fig. 1).Collaboratively with another team member, we conducted an initial screening of the basic information of the remaining 1758 articles.This process resulted in the exclusion of 1608 articles that did not meet the established criteria.Subsequently, from the pool of 150 potential articles, an additional 89 articles were excluded.Ultimately, 61 articles satisfied all the inclusion criteria and were included in our analysis, as detailed in Table 3.

Characteristics of included studies
The linguistic composition of the 61 articles included in our analysis was predominantly English, with 60 articles written in English and only one article in Chinese.Geographically, the distribution of research areas was varied: 24 articles originated from Asia, including China, Thailand, Japan, Singapore, and South Korea; 23 articles were from North America, specifically Canada and the United States; Europe contributed 8 articles, encompassing Greece, Italy, the Netherlands, Britain, and Ireland; Oceania, represented solely by Australia, accounted for 5 articles; and South America had one article from Chile, as detailed in Table 4.
Regarding the publication timeline, all articles were published in the twenty-first century, ranging from the earliest in 2003 to the most recent in 2022.Within the Asian context, 18 out of 24 articles focused on China, with 17 of these emanating from China's first-tier cities or provincial capitals such as Beijing, Shanghai, and Nanjing.Taiwan was the subject of four articles, and the remaining article focused on a non-provincial capital city.These findings indicate that aged care service resources and the application of related technology tend to be concentrated in economically prosperous urban areas, resulting in a greater diversity of research outputs.
Utilizing the titles and abstracts of the 61 articles, word clouds and connection diagram were generated after excluding irrelevant words, such as prepositions and adverbs.These visualizations are depicted in Fig. 2, 3.As evident from Fig. 2, the term 'accessibility' emerges with the highest frequency, closely followed by 'elderly' , 'service' , and 'spatial' .Figure 3 illustrates robust connections between keywords like 'elderly' , 'service' , 'accessibility' , and 'population' .This visualization underscores a prevalent research focus on accessibility and the strong association between older adults and the services they require.These figures not only reflect the thematic emphasis within the existing literature but also highlight the interconnected

Quality of articles included
Based on the Journal Citation Reports (JCR) data from 2021, the quality of the articles included in this review can be assessed.Out of the 61 articles, 28 were published in Q1 journals, representing approximately 46.0% of the total.Meanwhile, 29 articles were published in Q2-Q4 journals, accounting for about 44.3% of the selection.However, for 4 articles, the journal quality could not be determined due to either unavailability of information or inconsistencies in judging standards across different countries.Overall, the collected articles can be characterized as of moderately high quality.

Characteristics of target population
The target population in the 61 articles under review was primarily adults aged over 60, although the specific demographic varied across studies.16 articles focused on older adults within a specific age range, whereas the remaining 45 did not differentiate among senior groups.Specific subpopulations were the focus of some studies: 3 articles investigated older adults with dementia [14,16,47]; 4 articles centered on vulnerable elderly individuals [28,32,38,59].The subjects of the remaining 9 studies included older adults with disabilities [48], those unable to drive [33], individuals with chronic diseases [43], highrisk seniors [45], elderly prone to falls [57], those affected by COVID-19 [66], low-income older adults [69], and those in need of public transportation services [68].

Network analysis
The set of variables has been associated in the GIS environment with each arc of the pedestrian graph.
The accessibility levels also identify the critical areas that require priority interventions and the areas where it is possible to increase the levels of pedestrian accessibility to urban services.
Jongjit      The actual needs of the elderly should be taken into account when discussing their issues.

Hyemin Cho 2021 [73]
South Korea Elderly people in South Korea Quantitative: data Network analysis, spatial analysis, mapping Generating a map that includes road networks, public transportation routes and stops, and welfare facilities using a geographic information system (GIS).To improve the accessibility of low-accessibility areas, it is suggested that modifying the existing bus routes or adding new transit lines would reduce travel time of the elderly to welfare facilities.

Application of GIS
In the reviewed articles, the application of GIS was demonstrated through various methodologies.Among the 61 articles, the 2SFCA (two-step floating catchment area) method was employed in 11 articles [30, Table 4 61 Articles distributed by continent and country a As the research area of article [42] spans both Italy and England, for statistical convenience, this article has been categorized under "England"

Discussion
The analysis of the 61 articles in this review underscores that GIS applications exhibit varying characteristics and play diverse potential roles in aged care services, catering to different populations and service needs.Over nearly two decades, from 2003 to 2022, the utilization of GIS in aged care services has evolved considerably, particularly in the last five years, where development has been notably rapid.However, there still exist limitations in research methodologies and the specificity of target populations.This scoping review, conducted after a thorough screening and retrieval process, represents the first of its kind to focus on GIS applications in the field of aged care services.
The included articles showcased a variety of methods for applying GIS.Common approaches encompassed GIS-based modeling, creating illustrations with GIS, positioning and site selection, and utilizing a GIS database.Firstly, several articles integrated GIS with models, predominantly employing ABM and 2SFCA methods, accounting for 14 articles in total.ABM facilitated nuanced simulation and prediction, allowing for the construction of 'hypothetical' scenarios from multiple perspectives.This approach proved versatile in addressing diverse problems, meeting the needs of various groups, and aiding decision-making processes.The 2SFCA method was primarily used to assess accessibility and relative ease of access to different aged care service resources.Secondly, generating images using GIS technologies, particularly through software like Arc-GIS, was a widely used function.For instance, researchers utilized this capability to map feasible routes for older adults to access services, enhancing the efficiency of public resource utilization and catering to the needs of vulnerable elderly populations [33].This application aids in comprehending the distribution of facilities, mitigating resource distribution inequality, and visualizing care services.Furthermore, GIS was employed for location-specific purposes, such as identifying new sites for specialized medical shelters [32].Finally, some studies leveraged the information storage and management capabilities of GIS to gather data on public infrastructure locations and images, or to select sites for public facilities.
To accurately address research objectives, researchers often opted for multiple methods rather than relying on a singular approach.This multipronged strategy enabled a more nuanced analysis suitable for the complexities of each study.For instance, one study utilized GIS software to create a geographic database and developed a GISbased procedure to evaluate accessibility levels of urban services for the elderly.It selected the local primary health service in Naples as a case study and employed the 2SFCA method for evaluation, revealing significantly low levels of community accessibility [51].Such complex problems often require a multifaceted methodological approach to yield scientifically sound and reasonable results.Overall, GIS applications were diverse, with their specific uses varying both spatially and temporally, thereby enhancing their utility in research.
From 2003 to 2022, methods in aged care service research evolved from singular to more complex approaches.Initially, researchers focused on building theoretical frameworks, gradually incorporating various models and application software to translate theory into practical, applicable activities.The evolution in the aged population research mirrored this diversification.The target demographic shifted from a general, homogeneous elderly population to more specific, heterogeneous groups, including frail, chronically ill, and low-income older adults.
For instance, a Canadian study in 2003 utilized GIS to analyze fall patterns among older adults based on emergency department reports in specific regions, employing the empirical Bayesian method for prediction in Edmonton [57].This approach, though relatively straightforward, combined qualitative GIS methods with statistical analysis to draw universally applicable conclusions, setting a precedent for subsequent research.However, it lacked consideration of personal, environmental, and social factors.In contrast, a 2011 study from the United States advanced this research by using GIS to assist health planners in developing site selection strategies for fall prevention among older adults, employing ArcGIS's Network Analyst Extension [60].This study improved upon earlier research by considering geographical distribution, mobility, and actual travel time to destinations for older adults, thus encompassing more comprehensive factors.However, it did not account for the technical capacity of public health planners or changes in population density.
The distribution of research publications reveals that developed countries accounted for 40 papers, surpassing the number from developing countries, with a more diverse range of application methods.Developing countries contributed 21 papers, 18 of which originated from China, with only 3 from other countries.This disparity underscores the influence of economic development on scientific research capabilities and the extent of attention researchers devote to social issues.Nations with a higher volume of publications tended to explore more varied topics and focus on different demographic groups.For instance, the significance of oral care is well-recognized, and the dental industry in developed countries is well-established.All five articles on oral health care were from developed countries.Additionally, transportation accessibility is a crucial aspect of health resource accessibility, impacting the efficiency, effectiveness, and level of care resource access for older adults.Of the 27 articles focusing on accessibility, those from countries other than China were predominantly from developed nations like the United States, Japan, and Australia.It is also important to acknowledge that the needs for care services among older adults vary across different cultural backgrounds, and public facilities, the social environment, and local policies exert varying degrees of influence on aged care [74].Future research should consider socio-economic factors more thoroughly.
GIS, with its use of image data and calculation results, offers an intuitive understanding of the relationships between people and land, and between different land areas.Spatial analysis in GIS underscores the value of potential service spatiotemporal acquisition patterns.Data plays a vital role in GIS applications, especially when employing certain models and methods, where it relies heavily on data support.In studying the impact of public care services on older adults, the use of public data is essential.However, the transparency of public data is limited, and not all necessary data are readily accessible.Therefore, relevant public sectors and institutions could enhance data openness, establish public databases, and ease the challenges of data acquisition, enabling more effective research.Future developments might see GIS applications tailored for different institutions or departments, with research and development personnel creating features specific to various institutional types.For users, the operating interface and functions should be as user-friendly as possible.
Beyond data release, ethical considerations regarding data are also paramount.Although GIS databases typically do not involve highly specific personal data like home addresses or phone numbers, it is crucial for relevant sectors and institutions to prioritize the privacy and data security of older adults, implementing multi-level data management.If feasible, the formulation of laws and regulations in this regard might be beneficial.Additionally, it is observed that resources are often concentrated in densely populated urban areas.Within the 61 articles analyzed, 18 were focused on China, with 17 of these studies based in either first-tier or provincial capital cities.This trend indicates a tendency for researchers to focus on regions with more abundant resources.Large cities, with their dense populations and attractiveness to younger demographics, exhibit a certain balance in their population structure.In contrast, smaller cities often grapple with the migration of younger individuals to larger urban areas, exacerbating the aging issue and receiving less research attention.Consequently, there is a need for future research to focus on these less prominent cities and the aged care services they require.
An examination of the Web of Science database for reviews linking GIS and care services yielded 14 results, but none specifically targeted the elderly.This gap highlights the significant research value and importance of our work.Nonetheless, our review has its limitations.Firstly, due to the constraints in available literature, it includes only those articles retrieved before May 2022.Secondly, while this paper provides an overview of the specific GIS analysis methods used in the included literature, especially the more pertinent models, a more detailed discussion of these methods is warranted in future research.Given the universality of aging, this review holds both theoretical and practical significance.
As the demographic shift towards an aging population accelerates, urban planning must adapt accordingly, particularly in developing countries where rapid urbanization is significantly altering people's lives.Enhancing the city's environment to be more elderly-friendly requires bolstering supportive measures, both physical and nonphysical, to promote the sustainability of health care and social services.Given that GIS applications frequently involve data on population, economy, or facilities, governments could benefit from dynamically and timely updating relevant databases to aid in decision-making.The precision of data directly correlates with the realism of the results obtained.
Different countries should formulate and enact laws and policies that reflect their unique characteristics.In these policies, especially those concerning the allocation of aged care services or the planning of future resources, GIS can be a valuable tool for implementation.Considerations of efficiency and fairness are crucial in these allocations.For instance, in China, it is important that central and local policies align, are feasible, and effectively implemented.Moreover, problem analysis between different provinces and cities should be grounded in their specific realities and circumstances.
Future research should delve deeper into the care service needs of distinct subgroups within the elderly population.The characteristics of these groups can vary significantly, necessitating focused attention on vulnerable segments, such as individuals suffering from Alzheimer's disease, whose needs and challenges differ markedly from those without the condition [14].
The selected articles indicate nascent studies on the application of GIS to address the needs of older adults during the COVID-19 pandemic.Future investigations into COVID-19-related issues should pay closer attention to the unique care service requirements of older adults, encompassing both material and spiritual needs.GIS methods and technologies enable spatial and temporal interaction, which is particularly relevant as the needs of older individuals evolve throughout the course of the pandemic.Understanding the changing needs of different age groups at various stages will be a critical area of focus.To address the issues of inequitable distribution and inadequate accessibility of care services, it is advisable to integrate GIS with simulation methods such as ABM.This approach could enhance the delivery and effectiveness of care services to older adults and other vulnerable populations, ensuring their needs are met more comprehensively and effectively.

Conclusion
As the inaugural scoping review focusing on the application of GIS in aged care services, this study has illuminated the considerable development and maturation of GIS technology and its applications over the past two decades.GIS offers valuable insights by leveraging geographic information systems and spatial analysis, thereby underscoring the importance of potential spatio-temporal acquisition patterns in aged care services.This, in turn, enhances efficiency and fairness in service distribution.The application of GIS in this field exhibits distinct spatial and temporal variations.Developed countries have been early adopters of GIS, enabling them to address the needs of specific subpopulations of older adults more effectively.In contrast, research in developing countries has been relatively limited, with a notable lack of diversity in research methodologies.
The diverse needs of older adults have consistently been a focal point of research, leading to continuous enhancement in the understanding and provision of care services.Researchers from various countries and regions are increasingly focusing on localized research, enriching and completing the application of GIS in this field.Theoretically, there is a need for innovative methods and techniques, with research approaches being adaptively tailored to the specific issues under study.Practically, the varying needs of different age groups within the elderly population must be considered, and relevant public sectors and institutions should take responsibility for ensuring the efficiency and fairness of care service allocation.Moreover, data is a crucial component of GIS, and effective analysis relies on the availability of accurate and moderately open data sources.Moving forward, attention must be paid to the accessibility and precision of data to further the efficacy and impact of GIS applications in aged care services.

From a historical
perspective, the earliest studies included in this review were published in the United States and Canada in 2003, while the most recent publication originated from China in 2022.The temporal distribution of the articles shows a marked increase in recent years: a total of 20 articles were published from 2003 to 2017, and a significant uptick occurred from 2018 onwards, with 41 articles being published in the span from 2018 to 2022.

Table 1
Searching strategies AND "照护服务"(care service)OR "健康服务"(health care)Web of Science AND PubMed, Elsevier, EBSCO GIS OR "Geographic Information System"

Table 2
Quality evaluation

Table 3
Detailed information of included studies